Senior Medical Audit Specialist
Oklahoma State Government
Unknown, Oklahoma
Full-Time
$78,465
OfficeSenior
Job Posting Title
Senior Medical Audit SpecialistAgency
807 HEALTH CARE AUTHORITYSupervisory Organization
Program Integrity & AccountJob Posting End Date
Refer to the date listed at the top of this posting, if available. Continuous if date is blank.
Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Estimated Appointment End Date (Continuous if Blank)
Full/Part-Time
Full timeJob Type
RegularCompensation
$78,465.00/annualWhy You’ll Love Working Here
At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership, we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.
Let’s Talk Benefits
We know your great work deserves great support. Here’s a snapshot of what we offer for all eligible employees.
Generous state-paid benefit allowance to offset insurance premiums.
A wide selection of insurance plans with no pre-existing condition exclusions.
Flexible Spending Accounts for health care and dependent care.
Retirement Savings Plan with employer contributions.
11 paid holidays annually.
15 days of vacation and 15 days of sick leave in the first year.
Longevity Bonus recognizing years of public service.
Public Service Loan Forgiveness eligibility and tuition reimbursement.
Wellness benefits, including an on-site gym and fitness center discounts.
Job Description
Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105
Salary:$78,465.00/annual
Work Schedule: Monday – Friday
Primary Hours: 8:00 a.m. – 5:00 p.m.
Agency/Division Information
The Oklahoma Health Care Authority (OHCA)works to ensure Oklahomans have access to better health and better care.The agency’s core values include passion for purpose, trust and transparency,empowermentand accountability, best in class and outcome-driven, and servant leadership.As part of the interview process, candidates maybe requiredto attend an in-person interview at our Oklahoma City office.
Position Purpose
The Senior Medical Audit Specialist plays a critical role in safeguarding the integrity of healthcare services by providing clinical expertise in conducting audits and investigations to combat fraud, waste, and abuse. This position ensures compliance with OHCA policies, state statutes, and federal regulations through detailed analysis of billed services and documentation. By collaborating with internal and external stakeholders, the Senior Medical Audit Specialist helps to promote accountability and transparency in billing practices, supporting the overall mission of the Oklahoma Health Care Authority to provide better health and care for Oklahomans.
PrincipalActivitiesMay Include:
Provide clinical expertise in conducting investigations and completing comprehensive clinical audits in an effort to combat fraud, waste, and abuse.
Ensure billing compliance with OHCA policy, state statutes, and federal regulations.
Performs analysis and evaluation of billed services including claims and documentation to ensure all HCA policy requirements are met and services are clinically/medically appropriate.
Collaborate with others across the unit, organization, and external entities to evaluate audit results and make referrals toappropriate parties.
Communicate audit findings to all stakeholders.
Represents the Provider Audits Unit before an Administrative Law Judge (ALJ) and in legal proceedings regarding any general provider appeals, in an informed and professional manner.
Maintain licensure and certifications.
Other duties as assigned.
Knowledge, Skills, Abilities and Competency Requirements
The Senior Medical Audit Specialist requires in-depth knowledge of healthcare policies, state and federal regulations, and audit processes, as well as the ability to analyze complex billing data and ensure compliance. Strong communication and collaboration skills are essential to effectively convey audit findings and work with various stakeholders. This role demands strategic problem-solving and organizational skills to manage multiple tasks and resolve complex issues.
The best-fitting Korn Ferry competencies for this position include Ensures Accountability, as the role focuses on enforcing compliance and managing responsibilities, and Collaborates, given the need for cross-functional teamwork and stakeholder engagement.
**To be considered for this position your application must include a resume/CV with complete work and education history.**
Education and/or Experience:
Possession of a valid permanent Oklahoma license as a registered nurse as approved by the Oklahoma Board of Nursing or Registered Nurse License recognized by the Enhanced Nurse Licensure Compact (eNLC)
General understanding of coding principles (CPT, HCPCS, ICD-10 and /or DRG)
There is no substitution for licensure.
Preference Qualifications Include:
Certifications in any of the following areas: Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC)
Experience with Medicaid and Medicare billing audits
Experience in medical review, auditing, utilization review, compliance or regulatory work.
Physical Demands andWork Environment
Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels.In the course ofperforming job duties, employeesare required tospeak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.
Accommodation Statement
The Oklahoma Health Care Authoritycomplies withapplicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. Ifa reasonableaccommodation is needed toparticipatein the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.
Notice to applicants:
Please add OHCAHR@okhca.org to the address book or “safe-senders” list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application, you can contact the HR team at 405-522-7093.
Note:Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Current State of Oklahoma employees must apply for open positions internally through Workday Jobs Hub.
Equal Opportunity Employment
The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.
Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.
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